Advertisement

Pelvic Fractures in Polytrauma Patients

  • Peter V. Giannoudis
  • Christopher C. Tzioupis
  • Hans-Christoph Pape

In recent years, the surgical insult has been described, measured, and quantified with inflammatory mediators such as interleukins and other chemokines [1, 2, 3]. The “two-hit” theory for trauma patients indicates that the likelihood of developing post-traumatic complications is increased if several adverse impacts such as hemorrhage, infection, or surgery occur sequentially.

Keywords

External Fixation Pelvic Fracture Pelvic Ring Advance Trauma Life Support Sacral Fracture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Probst C, Probst T, Gaensslen A, Krettek C, Pape HC. The timing and duration of the initial pelvic stabilization after multiple trauma in patients from the German trauma registry: is there an influence on outcome. J Trauma 2007;62:370–377.PubMedCrossRefGoogle Scholar
  2. 2.
    Pape HC, Van GM, Rice J, Gansslen A, Hildebrand F, Zech S, Winny M, Lichtinghagen R, Krettek C. Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: determination of the clinical relevance of biochemical markers. J Trauma 2001;50:989–1000.PubMedCrossRefGoogle Scholar
  3. 3.
    Seekamp A, Jochum M, Ziegler M, van Griensven M, Martin M, Regel G. Cytokines and adhesion molecules in elective and accidental trauma-related ischemia/reperfusion. J Trauma 1998;44:874–882.PubMedCrossRefGoogle Scholar
  4. 4.
    Giannoudis PV, Hildebrand F, Pape HC. Inflammatory serum markers in patients with multiple trauma Can they predict outcome? J Bone Joint Surg Br 2004;86:313–323.PubMedCrossRefGoogle Scholar
  5. 5.
    Eastridge BJ, Burgess AR. Pedestrian pelvic fractures: 5 year experience of a major urban trauma center. J Trauma 1997;42:695–700.PubMedCrossRefGoogle Scholar
  6. 6.
    Flint L, Babikian G, Anders M, Rodriguez J, Steinberg S. Definitive control of mortality from severe pelvic fracture. Ann Surg 1990;211:703–707.PubMedCrossRefGoogle Scholar
  7. 7.
    Rommens PM. Pelvic ring injuries: a challenge for the trauma surgeon. Acta Chir Belg 1996;96:78–84.PubMedGoogle Scholar
  8. 8.
    Heetveld MJ, Harris I, Schlaphoff G, Sugrue M. Guidelines for the management of haemodynamically unstable pelvic fracture patients. ANZ J Surg 2004;74:520–29.PubMedCrossRefGoogle Scholar
  9. 9.
    Jones AL, Powell JN, Kellam JF, McCormack RG, Dust W, Wimmer P. Open pelvic fractures: A multicenter retrospective analysis. Orthop Clin North Am 1997;28:345–350.PubMedCrossRefGoogle Scholar
  10. 10.
    Rieger H, Joosten U, Probst A, Joist A. Significance of score systems in open complex trauma of the pelvis. Zentralbl Chir 1999;124:1004–1010.PubMedGoogle Scholar
  11. 11.
    Baker SP, O’Neil B, Haddon W, Long WB. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187–196.PubMedCrossRefGoogle Scholar
  12. 12.
    Ertel WK. General assessment and management of the polytrauma patient. In Tile M, Helfet DL, Kellam JF (eds), Fractures of the pelvis and acetabulum. 3rd Edition. Philadelphia, PA: Lippincott Williams & Wilkins, 2003, pp 61–79.Google Scholar
  13. 13.
    Borelli J, Koval K, Helfet D. The crescent fracture: A posterior fracture dislocation of the sacroiliac joint. J Orthop Trauma 1996;10:165–170.CrossRefGoogle Scholar
  14. 14.
    Kellam J. The role of external fixation in pelvic disruptions. Clin Orthop 1989;241:66–82.PubMedGoogle Scholar
  15. 15.
    Pohlemann T, Gänsslen A. Separation of the symphysis pubis. Orthop Traumatol 1999;7:144–154.Google Scholar
  16. 16.
    Routt M, Simonian P. Closed reduction and percutaneous skeletal fixation of sacral fractures. Clin Orthop 1996;329:121–128.PubMedCrossRefGoogle Scholar
  17. 17.
    Mirza A, Ellis T. Initial management of pelvic and femoral fractures in the multiply injured patient. Crit Care Clin 2004;20:159–170.PubMedCrossRefGoogle Scholar
  18. 18.
    Pohlemann T, Bosch U, Gansslen A, Tschern H. The Hannover experience in management of pelvic fractures. Clin Orthop 1994;305:69–80.PubMedGoogle Scholar
  19. 19.
    Failinger MS, McGanity PL. Unstable fractures of the pelvic ring. J Bone Joint Surg Am 1992;74:781–791.PubMedGoogle Scholar
  20. 20.
    Buckle R, Browner B, Morandi M. Emergency reduction for pelvic ring disruptions and control of associated hemorrhage using the pelvic stabilizer. Tech Orthop 1995;9:258–266.CrossRefGoogle Scholar
  21. 21.
    Gaensslen A, Pehlemann T, Paul C, Lobenhoffer P, Tscherne H. Epidemiology of pelvic ring injuries. Injury 1996;27:S-A13–S-A19.Google Scholar
  22. 22.
    Poka A, Libby E. Indications and techniques for external fixation of the pelvis. Clin Orthop 1996;329:54–59.PubMedCrossRefGoogle Scholar
  23. 23.
    Cothren CC, Osborn PM, Moore EE, Morgan SJ, Johnson JL, Smith WR. Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: A paradigm shift. J Trauma 2007;62:834–839.PubMedCrossRefGoogle Scholar
  24. 24.
    Velmahos GC, Toutouzas KG, Vassiliu P, Sarkisyan G, Chan L, Hanks S, Berne TV, Demetriades D. A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries. J Trauma 2002;53:303–308.PubMedCrossRefGoogle Scholar
  25. 25.
    Kimbrell BJ, Velmahos GC, Chan LS, Demetriades D. Angiographic embolization for pelvic fractures in older patients. Arch Surg 2004;139:728–733.PubMedCrossRefGoogle Scholar
  26. 26.
    Agolini SF, Shah K, Jaffe J, Newcomb J, Rhodes M, Reed JF. Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage. J Trauma 1997;43:395–399.PubMedCrossRefGoogle Scholar
  27. 27.
    Durkin A, Sagi HC, Durham R, Flint L. Contemporary management of pelvic fractures. Am J Surg 2006;192:211–223.PubMedCrossRefGoogle Scholar
  28. 28.
    American College of Surgeons. Advanced trauma life support, 7th edition. Chicago: American College of Surgeons, 2004.Google Scholar
  29. 29.
    Grimm M, Vrahas M, Thomas K. Pressure-volume characteristics of the intact and disrupted pelvic retroperitoneum. J Trauma 1998;44:454–459.PubMedCrossRefGoogle Scholar
  30. 30.
    Pape HC, Giannoudis PV, Krettek C. The timing of fracture treatment in polytrauma patients: Relevance of damage control orthopaedic surgery. Am J Surg 2002;183:622–629.PubMedCrossRefGoogle Scholar
  31. 31.
    Downs AR, Dhalla S. Hemorrhage and pelvic fractures. Can J Surg 1988;31:89–90.PubMedGoogle Scholar
  32. 32.
    Vahedi M, Ayuyao A, Parsa M, Freeman HP. Pneumatic antishock garment-associated compartment syndrome in injured lower extremities. J Trauma 1995;38:616–618.PubMedCrossRefGoogle Scholar
  33. 33.
    Giannoudis PV. Current concepts of the inflammatory response after major trauma: An update. Injury 2003;34:397–404.PubMedGoogle Scholar
  34. 34.
    Giannoudis PV. Surgical priorities in damage control in polytrauma. Joint Bone Joint Surg 2003;85-B:478–484.CrossRefGoogle Scholar
  35. 35.
    Pape HC, Giannoudis PV, Krettek C, Trentz O. Timing of fixation of major fractures in blunt polytrauma: Role of conventional indicators in clinical decision making. J Orthop Trauma 2005;19:551–562.PubMedCrossRefGoogle Scholar
  36. 36.
    Cryer HM, Miller FB, Evers BM, Rouben LR, Seligson DL. Pelvic fracture classification: Correlation with haemorrhage. J Trauma 1988;28:973–980.PubMedCrossRefGoogle Scholar
  37. 37.
    Pennal GB, Tile M, Waddell JP. Pelvic disruption: Assessment and classification. Clin Orthop 1980;151:12–22.PubMedGoogle Scholar
  38. 38.
    Boulanger BR, Kearney PA, Brenneman FD, Tsuei B, Ochoa J. FAST utilization 1999: Results of a survey of North American trauma centers. Am Surg 2000;66:1049–1055.PubMedGoogle Scholar
  39. 39.
    Theumann NH, Verdon JP, Mouhsine E, Denys A, Schnyder P, Portier F. Traumatic injuries: Imaging of pelvic fractures. Eur Radiol 2002;12:1312–1330.PubMedCrossRefGoogle Scholar
  40. 40.
    Ebraheim NA, Savolaine ER, Rusin JR, Jackson WT, Asensio JA. Occult rectal perforation in a major pelvic fracture. J Orthop Trauma 1988;2:340–343.PubMedCrossRefGoogle Scholar
  41. 41.
    Kumar BA, Chojnowski AJ. Open pelvic fractures with vaginal laceration: An unusual clinical feature. Injury 2000;31:68–70.PubMedCrossRefGoogle Scholar
  42. 42.
    Magen AB, Moser RP, Woomert CA, Guidici MA. Septic arthritis of the hip: a complication of a rectal tear associated with pelvic fractures. Am J Roentgenol 1991;156: 817–818.Google Scholar
  43. 43.
    Ross GL, Dodd O, Lipham JC, Campbell JK. Rectal perforation in unstable pelvic fractures: The use of flexible sigmoidoscopy. Injury 2001;32:67–68.PubMedCrossRefGoogle Scholar
  44. 44.
    Berg EE, Chebuhar C, Bell RM. Pelvic trauma imaging: a blinded comparison of computed tomography and roentgenograms. J Trauma 1996;41:994–998.PubMedCrossRefGoogle Scholar
  45. 45.
    Guillamondegui OD, Pryor JP, Gracias VH, Gupta R, Reilly PM, Schwab CW. Pelvic radiography in blunt trauma resuscitation: A diminishing role. J Trauma 2002;53:1043–1047.PubMedCrossRefGoogle Scholar
  46. 46.
    Dalal SA, Burgess AR, Siegel JH, Young JW, Brumback RJ, Poka A, Dunham CM, Gens D, Bathon H. Pelvic fracture in multiple trauma: Classification by mechanism is key to pattern of organ injury, resuscitative requirements and outcome. J Trauma 1989;29:981–1002.PubMedCrossRefGoogle Scholar
  47. 47.
    Young JWR, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: Value of plain radiography in early assessment and management. Radiology 1986;160:445–451.PubMedGoogle Scholar
  48. 48.
    Burgess AR, Eastridge BJ, Young JWR, Ellison TS, Ellison Jr PS, Poka A, Bathon GH, Brumback RJ. Pelvic ring disruptions: Effective classification system and treatment protocols. J Trauma 1990;30:848–856.PubMedCrossRefGoogle Scholar
  49. 49.
    Poole GV, Ward EF, Muakkassa FS, Hsu HSH, Griswold JA, Rhodes RS. Pelvic fracture from major blunt trauma. Ann Surg 1991;213:532–539.PubMedCrossRefGoogle Scholar
  50. 50.
    Gruen GS, Leit ME, Gruen RJ, Peitzman AB. The acute management of hemodynamically unstable multiple trauma patients with pelvic ring fractures. J Trauma 1994;36:706–713.PubMedCrossRefGoogle Scholar
  51. 51.
    Eastridge BJ, Starr A, Minei JP, O’Keefe GE. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma 2002;53:446–451.PubMedCrossRefGoogle Scholar
  52. 52.
    Moreno C, Moore EE, Rosenberger A, Cleveland HC. Haemorrhage associated with major pelvic fracture. J Trauma 1986;26:987–989.PubMedCrossRefGoogle Scholar
  53. 53.
    Resnik CS, Stackhouse DJ, Shanmuganathan K, Young JW. Diagnosis of pelvic fractures in patients with acute pelvic trauma: efficacy of plain radiographs. Am J Roentgenol 1992;158:109–112.Google Scholar
  54. 54.
    Robertson DD, Sutherland CJ, Chan BW, Hodge JC, Scott WW, Fishman EK. Depiction of pelvic fractures using 3D volume tric holography: Comparison of plain X-ray and CT. J Comput Assist Tomogr 1995;19:967–974.PubMedCrossRefGoogle Scholar
  55. 55.
    Govender S, Sham A, Singh B. Open pelvic fractures. Injury 1990;21:373–376.PubMedCrossRefGoogle Scholar
  56. 56.
    Koraitin MM. Pelvic fracture urethral injuries: The unresolved controversy. J Urol 1999;161:1433–1441.CrossRefGoogle Scholar
  57. 57.
    Morehouse DD. Injuries to the urethra and urinary bladder associated with fractures of the pelvis. Can J Surg 1988;31:85–88.PubMedGoogle Scholar
  58. 58.
    Frank LR. Is MAST in the past? The pros and cons of MAST usage in the field. J Emerg Med Serv 2000;25:38–41.Google Scholar
  59. 59.
    Clarke G, Mardel S. Use of MAST to control massive bleeding from pelvic injuries. Injury 1993;24:628–629.PubMedCrossRefGoogle Scholar
  60. 60.
    Dickinson K, Roberts I. Medical anti-shock trousers (pneumatic anti-shock garments) for circulatory support in patients with trauma (Cochrane Review). The Cochrane Library, Issue 2. Oxford: Update Software, 2003.Google Scholar
  61. 61.
    Bottlang M, Krieg JC, Mohr M, Simpson TS, Madey SM. Emergent management of pelvic ring fractures with use of circumferential compression. J Bone Joint Surg 2002;84-A(Suppl 2):43–47.PubMedGoogle Scholar
  62. 62.
    Routt M, Falicov A, Woodhouse E, Schildhauer TA. Circumferential pelvic antishock sheeting: A temporary resuscitation aid. J Orthop Trauma 2002;16:45–48.PubMedCrossRefGoogle Scholar
  63. 63.
    Vermeulen B, Peter R, Hoffmeyer P, Unger P-F. Prehospital stabilization of pelvic dislocations: A new strap belt to provide temporary hemodynamic stabilization. Swiss Surg 1999;5:43–46.PubMedCrossRefGoogle Scholar
  64. 64.
    Bottlang M, Simpson T, Sigg J, Krieg JC, Madey SM, Long WB. Noninvasive reduction of open-book pelvic fractures by circumferential compression. J Orthop Trauma 2002;16:367–373.PubMedCrossRefGoogle Scholar
  65. 65.
    Mears DC. Clinical techniques in the pelvis. In Mears DC (ed), External skeletal fixation. Baltimore, MD: Williams and Wilkins, 1983, p 342.Google Scholar
  66. 66.
    Connor GS, McGwin G Jr PA, Alonso JE, Rue 3rd LW. Early versus delayed fixation of pelvic ring fractures. Am Surg 2003;69:1019–1023.PubMedGoogle Scholar
  67. 67.
    Tile M. Pelvic fractures: should they be fixed? J Bone Joint Surg 1988;70-B:1–12.Google Scholar
  68. 68.
    Garcia JM, Doblare M, Seral B, Seral F, Palanca D. Three dimensional finite element analysis of several internal and external pelvis fixations. J Biomech Engin 2000;122:516–522.CrossRefGoogle Scholar
  69. 69.
    Gänsslen A, Giannoudis P, Pape HC. Haemorrhage in pelvic fracture: Who needs angiography? Curr Opin Crit Care 2003;9:515–523.PubMedCrossRefGoogle Scholar
  70. 70.
    Giannoudis PV, Tzioupis CC, Pape HC, Roberts CS. Percutaneous fixation of the pelvic ring: An update. J Bone Joint Surg Br 2007;89-B:145–154.CrossRefGoogle Scholar
  71. 71.
    Ganz R, Krushell AJ, Jakob RP, Kuffer J. The antishock pelvic clamp. Clin Orthop 1991;267:71–78.PubMedGoogle Scholar
  72. 72.
    Mohanty K, Musso D, Powell JN, Kortbeek JB, Kirkpatrick AW. Emergent management of pelvic ring injuries: An update. Can J Surg 2005;48:49–56.PubMedGoogle Scholar
  73. 73.
    Tile M. Acute pelvic fractures: II. Principles of management. J Am Acad Orthop Surg 1996;4:152–161.PubMedGoogle Scholar
  74. 74.
    Barei DP, Bellabarba C, Mills WJ, Routt ML Jr. Percutaneous management of unstable pelvic ring disruptions. Injury 2001;32(Suppl 1):S-A33–S-A44.Google Scholar
  75. 75.
    Buhren V, Trentz O. Intraluminare ballonblockade der aorta bei traumatischer massivblutung. Unfallchirurg 1989;92:309–313.PubMedGoogle Scholar
  76. 76.
    Platz A, Friedl H, Kohler A, Trentz O. Chirurgisches management bei schweren beckenquetschverletzungen. Helv Chir Acta 1992;58:925–929.PubMedGoogle Scholar
  77. 77.
    Saueracker AJ, McCroskey BL, Moore EE, Moore FA. Intraoperative hypogastric artery embolization for life-threatening pelvic hemorrhage: A preliminary report. J Trauma 1987;27:1127–1129.PubMedCrossRefGoogle Scholar
  78. 78.
    Tötterman A, Madsen JE, Skaga NO, Røise O. Extraperitoneal pelvic packing: A salvage procedure to control massive traumatic pelvic hemorrhage. J Trauma 2007;62:843–852.PubMedCrossRefGoogle Scholar
  79. 79.
    Huittinen V-M, Slatis P. Postmortem angiography and dissection of the hypogastric artery in pelvic fractures. Surgery 1973;73:454–462.PubMedGoogle Scholar
  80. 80.
    Biffl WL, Smith WR, Moore EE, Gonzalez RJ, Morgan SJ, Hennessey T, Offner P, Ray Jr CE, Franciose RJ, Burch JM. Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures. Ann Surg 2001;233:843–850.PubMedCrossRefGoogle Scholar
  81. 81.
    Perez JV, Hughes TM, Bowers K. Angiographic embolisation in pelvic fracture. Injury 1998;29:187–191.PubMedCrossRefGoogle Scholar
  82. 82.
    Balogh Z, Caldwell E, Heetveld M, D’Amours S, Schlaphoff G, Harris I, Sugrue M. Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: Do they make a difference? J Trauma 2005;58:778–782.PubMedCrossRefGoogle Scholar
  83. 83.
    The Eastern Association for the Surgery of Trauma website. Available at: http://www.east.org/tpg/pelvis.pdf. Accessed July 7th, 2007.
  84. 84.
    Hagiwara A, Minakawa K, Fukushima H, Murata A, Masuda H, Shimazaki S. Predictors of death in patients with life-threatening pelvic haemorrhage after successful transcatheter arterial embolisation. J Trauma 2003;55:696–703.PubMedCrossRefGoogle Scholar
  85. 85.
    Panetta T, Sclafani SGA, Goldstein AS, Phillips TF, Shaftan GW. Percutaneous transcatheter embolisation for massive bleeding from pelvic fractures. J Trauma 1985;25:1021–1029.PubMedGoogle Scholar
  86. 86.
    Hamill J, Holden A, Paice R, Civil I. Pelvic fracture pattern predicts arterial hemorrhage. ANZ J Surg 2000;70:338–343.CrossRefGoogle Scholar
  87. 87.
    Miller PR, Moore PS, Mansell E, Meredith JW, Chang MC. External fixation or arteriogram in bleeding pelvic fracture: initial therapy guided by markers of arterial hemorrhage. J Trauma 2003;54:437–443.PubMedCrossRefGoogle Scholar
  88. 88.
    Velmahos GC, Chahwan S, Falabella A, Hanks SE, Demetriades D, Moore EE. Angiographic embolisation for intraperitoneal and retroperitoneal injuries. World J Surg 2000;24:539–545.PubMedCrossRefGoogle Scholar
  89. 89.
    Gourlay D, Hoffer E, Routt M, Bulger E. Pelvic angiography for recurrent traumatic pelvic arterial hemorrhage. J Trauma 2005;59:1168–1174.PubMedCrossRefGoogle Scholar
  90. 90.
    Wolinsky PR. Assessment and management of pelvic fracture in the hemodynamically unstable patient. Orthop Clin North Am 1997;28:321–329.PubMedCrossRefGoogle Scholar
  91. 91.
    Ertel W, Karim E, Keel M, Trentz O. Therapeutical strategies and outcome of polytraumatized patients with pelvic injuries. Eur J Trauma 2000;6:278–286.CrossRefGoogle Scholar
  92. 92.
    Ertel W, Keel M, Eid K, Platz A, Trentz O. Control of severe hemorrhage using c-clamp and pelvic packing in multiply injured patients with pelvic ring disruption. J Orthop Trauma 2001;15:468–474.PubMedCrossRefGoogle Scholar
  93. 93.
    Giannoudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury 2004;35:671–677.PubMedCrossRefGoogle Scholar
  94. 94.
    Rout ML Jr, Nork SE, Mills WJ. High energy pelvic ring disruptions. Orthop Clin North Am 2002;33:59–72.CrossRefGoogle Scholar
  95. 95.
    Routt Jr ML, Nork SE, Mills WJ. Percutaneous fixation of pelvic ring disruptions. Clin Orthop 2000;375:15–29.PubMedCrossRefGoogle Scholar
  96. 96.
    Switzer JA, Nork SE, Routt Jr ML. Comminuted fracture of the iliac wing. J Orthop Trauma 2000;14:270–276.PubMedCrossRefGoogle Scholar
  97. 97.
    Leenen LP, van der Werken C, Schoots F, Goris RJ. Internal fixation of open pelvic fractures. J Trauma 1993;35:220–225.PubMedCrossRefGoogle Scholar
  98. 98.
    Parker MJ, Roberts C. Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev 2001;4:CD001825Google Scholar
  99. 99.
    Kudsk KA, Hanna MK. Management of complex perineal injuries. World J Surg 2003;27:895–900.PubMedCrossRefGoogle Scholar
  100. 100.
    Kudsk KA, Sheldon GF, Walton RL. Degloving injuries of the extremity and the torso. J Trauma 1981;21:835–839.PubMedCrossRefGoogle Scholar
  101. 101.
    Faringer PD, Mullins RJ, Feliciano PD, Duwelius PJ, Trunkey DD. Selective faecal diversion in complex open pelvic fractures from blunt trauma. Arch Surg 1994;129:958–963.PubMedGoogle Scholar
  102. 102.
    Wong RW, Rappaport WD, Witzke D, Putnam CW, Hunter GC. Factors influencing the safety of colostomy closure in the elderly. J Surg Res 1994;57:289–292.PubMedCrossRefGoogle Scholar
  103. 103.
    Bulger EM, McMahon K, Jurkovich GJ. The morbidity of penetrating colon injury. Injury 2003;34:41–46.PubMedCrossRefGoogle Scholar
  104. 104.
    Raman R, Senior C, Segura P, Giannoudis PV. Management of scrotal swelling after pelvic and acetabular fractures. Br J Nurs 2004;13:458–461.PubMedGoogle Scholar
  105. 105.
    Klingman R, Smith P, Stromberg B, Valentine J, Goebel M. Traumatic hemipelvectomy. Ann Plast Surg 1991;27:156–163.PubMedCrossRefGoogle Scholar
  106. 106.
    Rieger H, Dietl KH. Traumatic hemipelvectomy: An update. J Trauma 1998;45:422–426.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Peter V. Giannoudis
    • 1
  • Christopher C. Tzioupis
  • Hans-Christoph Pape
  1. 1.Trauma and Orthopaedic SurgeryUniversity of Leeds, Leeds General Infirmary, University HospitalLeedsUK

Personalised recommendations